Chew on This: Diet and Your Pelvic Floor

In Pelvic Floor Physical Therapy by pelv_admin2 Comments

When I was younger, the phrase “You are what you eat,” totally confused me. Doughnuts are so delicious and sweet, therefore if I eat a half dozen of glazed old fashioned doesn’t that mean that I would also be sweet and highly desirable? Obviously, I now know that my logic as a kid was inaccurate, otherwise I would still be on a doughnut and milkshake diet. I now know the importance of healthy eating and the benefits of fruits and veggies.


This discovery came from my own health journey, which may sound familiar to many of you. No doctor could figure out why I had horrible abdominal pain. I had constant fatigue and headaches. I underwent a plethora of tests, but no one could give me any answers. Thankfully, my mom (the wisest woman I know) suggested I do a food journal to see if something in my diet was the problem. After, only a few days of tracking my diet, I noticed several unhealthy trends. I began researching strategies to improve my diet and began to notice improvement in my health and less symptoms overall. I was amazed that something as simple as eating more “green things” could make me feel better. In reality, it makes so much sense. What we supply our body with will impact how it will run. For me, I was not being mindful of what I was eating or buying at the grocery store. Since the frozen food and packaged items I purchased were labeled as organic or vegan then I assumed that they must be good for me. No wonder my body hurt so much, I was not feeding it anything of substance! This experience made me to want to know more about how diet can impact not only myself, but my patients as well.


I was fortunate to learn about how nutrition can play a role in patients with pelvic floor dysfunction as I recently completed a certification program as a Women’s Health and Nutrition Coach through the Integrative Women’s Health Institute. The integrative Women’s Health Institute was founded by Jessica Drummond, a pelvic floor physical therapist and a health coach with a certification in clinical nutrition. Jessica founded the Institute to help educate professionals and patients about functional nutrition and its role in pelvic health and pain disorders. The programs Jessica offers are very informative and in-depth, so there is no way to share all of the information in one blog post, but there are a few key tidbits that I feel everyone could benefit from.


First, every person is unique, therefore when it comes to diets there is no one size fits all. What one person may lack and therefore require in nutrients, another person may have in abundance. I recommend that one consult with an integrative medical provider, naturopath or dietician before making any drastic changes to their diet. Lab tests may be helpful in determining if you are deficient in certain vitamins, which can help you and your provider decide foods that can be helpful in correcting the deficit.


Rule out food sensitivities. If you read Liz’s blog post on the gut microbiome, you may recall that the gut plays a huge role in immune health. So, if certain foods irritate the lining of the gut, it can result in an overall inflammatory response that is not just limited to the gut region. If a person continues to eat a food that they are particularly sensitive to, it can lead to chronic inflammation that can lead to pain anywhere in the body, such as the pelvis. For some people, food sensitivities can present as fatigue, skin conditions such as eczema, brain fog, nausea or headaches to name a few.


So, how does one determine if they have any food sensitivities?


If only there was an app for that, where when you swipe right for cheese and hope that you get a notification that you were a match! In the meantime, there are two options. One is a blood test can look for different inflammatory markers that can be related to food sensitivities. The other is the gold standard in terms of effectiveness: an elimination diet.


The name should hopefully explain the process. You eliminate all foods that are most likely to cause food sensitivities for at least 3 weeks. Drummond recommends eliminating the following: gluten, dairy, soy, eggs, corn, beef, citrus fruits, peanuts, coffee, baker’s yeast, potatoes, onions and nightshade vegetables. After the 3 weeks have passed, you add one item back into your diet for 1-4 days and then remove it and monitor your symptoms. If you experience symptoms, wait until the symptoms resolve before you add a different food back in. If you identify an item that you are sensitive to, you must eliminate it from your diet for 3-6 months. This would be the time to add in gut healing foods, such as bone broth, which is high in glutamine an amino acid that supports gut epithelial health. You can make your own bone broth or you can order it online here or here. You may still be stuck on the list of foods you need to eliminate on the diet and if you are like me are thinking What the heck am I supposed to eat?! Lots of things: Organic hormone-free lean protein such as chicken or salmon, leafy greens, apples, avocados, beans and lentils. It may seem like a daunting task, but the results gained from doing an elimination diet should make it worthwhile.


One final note regarding food sensitivities, if you suspect you may be gluten intolerant or have Celiac’s Disease you should consult with a medical provider, as the testing to rule out this disorder requires ingesting gluten versus eliminating it.


So let’s say you’ve done an elimination diet or maybe you aren’t ready to do one or don’t feel that it is beneficial for you and you want to know what else can you do to support your body and decrease inflammation related to your pelvic floor dysfunction.


  • Drink water! Your body needs water to stay hydrated, to flush out toxins and keep your colon happy. Dehydration can lead to bowel dysfunction, primarily: constipation. Constipation can play a huge role in contributing to pelvic floor dysfunction. Stephanie talked about this in more detail in a previous blog post.  Previously, everyone lived by the rule of 8 cups of water a day. That is a great way to start, but not everyone needs the same amount of water. The new rule of thumb is to drink the amount of water best suited for your body weight. You should take your weight and divide that number in half and the result is the amount you should drink in ounces. For example: If you are 200 pounds, you should ideally drink 100 ounces of water a day. For every 30 minutes you exercise, you should add in an extra 8-12 ounces. Other factors may require you to increase your water intake such as being pregnant, if you are breast-feeding or undergoing different medical treatments such as chemotherapy.


  • Eat real food.  In order to help your body function to it’s full potential, you need to feed it high quality, nutrient dense food. Try to stick to organic fruits and vegetables and grass fed, organic and hormone-free meat. Some examples include cruciferous vegetables, broccoli, avocados, wild salmon and other lean proteins, and lemon. Avoid processed foods, frozen meals or meal replacement bars. They often contain high amounts of oil, sugar and fat and very little fiber or nutrients. Some processed foods can contain large amounts of chemicals which are used to add flavor or prolong the shelf life of the item. For all of those reasons, processed food can lead to the inflammatory process I discussed above.


  • Limit your sugar intake. Increased sugar consumption can lead to elevated cortisol (a stress hormone) levels which can have a negative impact on your sex hormones. Elevated cortisol can cause a bunch of other  symptom such as headaches, sleep problems and weight gain.  


  • Spice up your life! Certain spices such turmeric, garlic, ginger, oregano, cloves, dill, sweet basil and cinnamon have anti-inflammatory properties. Be mindful that certain spices, such as pepper, are nightshades and can be irritating for some people. Other anti-inflammatory foods include: Lime zest, button mushroom, oyster mushroom, onion, sweet potato, parsley

Now that is definitely not everything you need to know, and it is certainly not the solution for everyone’s pelvic dysfunction. As we know, chronic pain is not something that can be treated with a magic pill. It usually requires a multi-disciplinary approach with different providers and interventions being utilized. A person’s diet can often be forgotten when discussing strategies to treat pelvic pain and dysfunction. Changing one’s diet does not mean it will eliminate one’s symptoms, but it can certainly help supplement other treatment modalities.



Want to learn more? Check out the following resources for more information:


The Elimination Diet: Discover the Foods That Are Making You Sick and Tired–and Feel Better Fast by Tom Malterre MS, CN and Alissa Segersten


The Integrative Women’s Health Institute:


Prescription for Nutritional Healing by Phyllis A. Balch


What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.


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